Healthcare Provider Details

I. General information

NPI: 1033373501
Provider Name (Legal Business Name): MIRTA MARTINEZ-KEKENAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 66TH ST # Y3
LARGO FL
33773-3434
US

IV. Provider business mailing address

12360 66TH ST # Y3
LARGO FL
33773-3434
US

V. Phone/Fax

Practice location:
  • Phone: 727-558-1344
  • Fax:
Mailing address:
  • Phone: 727-558-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: